Published Date: 2012-11-21 07:41:55
Subject: PRO/EDR> Dengue - Portugal (03): (MA) ECDC
Archive Number: 20121121.1417734

DENGUE - PORTUGAL (03): (MADEIRA) ECDC
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[1]
Date: Tue 20 Nov 2012
Source: European Centre for Disease Prevention and Control [ECDC] [edited]
http://www.ecdc.europa.eu/en/press/news/Lists/News/ECDC_DispForm.aspx?List=32e43ee8-e230-4424-a783-85742124029a&ID=788


Update: risk assessment on dengue cases in Madeira
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The Autonomous Region of Madeira constituted the 1st known occurrence of locally transmitted dengue infection on the island on 3 Oct 2012 when the Public Health Authority of Portugal reported 2 cases of dengue infection in residents. These infections in patients residing in Madeira mark the 1st sustained transmission of dengue in the European Union since the 1920s.

Local transmission of dengue infection has been now established for several weeks on Madeira and as of 11 Nov 2012, the Portuguese Ministry of Health reported 1357 cases of dengue infection from the public health sector in Madeira. 669 of these cases were laboratory confirmed, 688 probable cases. Since the beginning of the outbreak, 89 patients were hospitalised and 5 currently remain in hospital. So far, 25 patients have been diagnosed with dengue after returning from the island: cases were reported from mainland Portugal (9), the UK (6), Germany (7), Sweden (1), and France (2).

In the meantime, Portuguese and regional health authorities have been implementing control measures to limit extension of the outbreak to reduce the risk of sustained transmission locally and that of exportation of infected vectors from the island. In addition, ECDC provided technical assistance to the health authorities in Madeira in their efforts to control the outbreak by deploying an expert mission from 22 Oct-16 Nov [2012]. Following this visit, ECDC updated its initial rapid risk assessment on the situation. The updated assessment reconfirms that the current epidemiological situation does not imply any trade or travel restriction beyond the disinfestations implemented on the island at present.

However, residents as well as tourists are strongly advised to take individual protective measures -- like using repellents -- to avoid mosquito bites. Dengue [virus] is transmitted by a daytime mosquito (_Aedes aegypti_) and thus protective measures should be applied throughout the whole day.

The latest data indicate that the outbreak is still ongoing and its exact development cannot be anticipated at this point of time. With tourists visiting Madeira, continued import of dengue cases from the island to other EU countries is to be expected until the mosquito population is decreased and transmission interrupted.

Anyone who develops a fever or flu-like symptoms (with severe headache, retro-orbital pain, myalgia, arthralgia, and maculo-papular rash) within 2 weeks of returning from a trip to Madeira should seek medical advice.

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[2]
Date: Tue 20 Nov 2012
Source: ECDC Rapid Risk Assessment [edited]
http://www.ecdc.europa.eu/en/publications/Publications/dengue-madeira-risk-assessment-update.pdf


Update: autochthonous dengue cases in Madeira
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Main conclusions and recommendations:
This is the 1st sustained transmission of dengue in the European Union since the 1920s. Autochthonous transmission is likely to continue until the end of the year when mosquito density will probably decrease.

The epidemiological situation does not imply any trade or travel restriction beyond the disinfestations currently being implemented.

As the influenza transmission season will commence around the end of the year, concomitant actions for monitoring dengue and influenza are being launched in Madeira.

Aircraft disinfection and control of vector mosquitoes at ports and airports in Madeira should be continued.

National and regional (Madeira) public health authorities in Portugal have implemented appropriate control measures and the risk of transmitting dengue through blood or other substances of human origin in Madeira is currently mitigated. For visitors returning from Madeira, deferral should be considered by Member States, in accordance with section 2.3, Annex III of the Commission Directive 2004/33/EC of 22 March 2004.

Residents and travellers visiting the island of Madeira are strongly advised to take individual protective measures to avoid mosquito bites. Dengue is transmitted by a daytime mosquito and consequently protective measures must be applied throughout the day.

Travellers experiencing febrile symptoms with severe headache, retro-orbital pain, myalgia, arthralgia, and maculo-papular rash within 21 days of visiting Madeira are advised to seek medical advice. ECDC is gathering information on confirmed cases reported by EU/EEA Member States.

Neighbouring geographical areas (such as the Canary Islands) and other EU Member States need to assess the risk of _Aedes_ mosquito populations becoming established and dengue being introduced. Surveillance activities need to be implemented on the basis of such a risk assessment.

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[Although 25 individuals acquired their dengue virus infections on Madeira Island, there is essentially no likelihood of ongoing transmission in their home countries because mosquito vectors are either not present or inactive at this time of year. One hopes that the measures adopted by the Madeira Island residents, coupled with cooler weather, will result in a decline in virus transmission. One also hopes that neighboring islands will be vigilant and intensify surveillance to avoid spread of the outbreak. It would be of interest to know if the Madeira Island dengue outbreak has adversely affected tourism there.

A HealthMap/ProMED-mail interactive map showing the location of Madeira Island in the Atlantic Ocean can be accessed at http://healthmap.org/r/3DHw. - Mod.TY]

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